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Dipyridamole-thallium/sestamibi before vascular surgery: a prospective blinded study in moderate-risk patients
C de Virgilio1, K Toosie, M Elbassir
1Departments of Surgery, Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
Insights
Reversible defects on dipyridamole-thallium (DTHAL)/sestamibi (DMIBI) imaging did not predict adverse cardiac events in patients undergoing elective vascular surgery. This finding suggests DTHAL/DMIBI may not be a reliable predictor for this patient group.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Vascular Surgery
Background:
- Assessing cardiac risk before vascular surgery is crucial for patient outcomes.
- Dipyridamole-thallium (DTHAL) and sestamibi (DMIBI) imaging are used to evaluate myocardial perfusion.
- Predictive value of imaging findings in moderate-risk surgical patients requires further investigation.
Purpose of the Study:
- To prospectively evaluate if reversible defects on DTHAL/DMIBI predict adverse cardiac events after elective vascular surgery.
- To assess the association between myocardial perfusion defects and perioperative cardiac complications in at-risk patients.
Main Methods:
- Prospective, blinded study of 80 patients with clinical risk factors undergoing elective vascular surgery.
- Preoperative DTHAL/DMIBI imaging performed, excluding patients with recent heart failure or unstable angina.
- Adverse cardiac events, including myocardial infarction and cardiac death, were monitored post-surgery.
Main Results:
- No significant association was found between reversible defects on DTHAL/DMIBI and adverse cardiac events (14% vs. 9.8%, P=.71).
- The cardiac event rate was similar for patients with and without reversible defects.
- Sensitivity for predicting events was low (11%), while specificity was high (90%).
Conclusions:
- Reversible defects on DTHAL/DMIBI imaging do not appear to predict adverse cardiac events in moderate-risk patients undergoing elective vascular surgery.
- The study suggests that DTHAL/DMIBI may have limited utility in risk-stratifying these patients.
- Further research may be needed to identify more accurate predictors of cardiac events in this population.
Purpose:
This study assessed in a prospective, blinded fashion whether a reversible defect on dipyridamole-thallium (DTHAL)/sestamibi (DMIBI) can predict adverse cardiac events after elective vascular surgery in patients with one or more clinical risk factors.
Methods:
Consecutive patients with one or more clinical risk factors underwent a preoperative blinded DTHAL/DMIBI. Patients with recent congestive heart failure (CHF) or myocardial infarction (MI) or severe or unstable angina were excluded.
Results:
Eighty patients (78% men; mean age, 65 years) completed the study. Diabetes mellitus was the most frequent clinical risk factor (73%), followed by age older than 70 years (41%), angina (29%), Q wave on electrocardiogram (26%), history of CHF (7%), and ventricular ectopy (3%). The results of DTHAL/DMIBI were normal in 36 patients (45%); a reversible plus or minus fixed defect was demonstrated in 28 patients (36%), and a fixed defect alone was demonstrated in 15 patients (19%). Nine adverse cardiac events (11%) occurred, including three cases of CHF, and one case each of unstable angina, Q wave MI, non-Q wave MI, and cardiac arrest (successfully resuscitated). Two cardiac deaths occurred (2% overall mortality), one after a Q wave MI and one after CHF and a non-Q wave MI. The cardiac event rate was 14% for reversible defect and 9.8% without reversible defect (P =.71). The cardiac event rate was 12.5% (one of eight cases) for two or more reversible defects, versus 11.1% (eight of 72 cases) for fewer than two reversible defects (P = 1.0). The sensitivity rate of two or more areas of redistribution was 11% (95% CI, 0.3%-48%), the specificity rate was 90%, and the positive and negative predictive values were 12.5% and 89%, respectively.
Conclusion:
Our study demonstrated no association between reversible defects on DTHAL/DMIBI and adverse cardiac events in moderate-risk patients undergoing elective vascular surgery.